SPONTANEOUS BACTERIAL PERITONITIS

MICROBIOLOGICAL ANALYSIS OF ASCITIC FLUID IN PATIENTS WITH COMPLICATED LIVER CIRRHOSIS

Abstract

Spontaneous bacterial peritonitis is a serious event in patients with liver cirrhosis and associated with significant morbidity and mortality. Most common causative organisms of SBP are E.coli, streptococcus pneumonia and klebsiella. Liver cirrhosis has multifactorial etiology and the most common causes in our country are hepatitis C and hepatitis B. Objectives: (1) To observe the culture and sensitivity pattern of ascitic fluid in patients with liver cirrhosis. (2) To examine the resistance against various antibiotics. Period: 6 months. Setting: Study was conducted in department of Gastroenterology Hepatology in collaboration with department of microbiology of Sheikh Zayed Hospital, Lahore. Materials and Methods: Sample size; 80 patients of liver cirrhosis with ascites. Sampling technique, Non probability purposive technique was adopted. Sample selection; By Inclusion and Exclusion criteria. Data collection procedure; Eighty patients with liver cirrhosis and ascites diagnosed on the basis of history, examination and ultrasound findings. After detailed history examination and full aseptic measures at least 10 ml of ascitic fluid in 20ml syringe with 16G needle was drawn in blood culture bottle at bed side and was sent to microbiology laboratory for culture and sensitivity and record of resistance and sensitivity against various antibiotics used to treat SBP. Data analysis procedure; Data was analyzed by SPSS version 10.Quantitative variables and were recorded as mean + S.D and qualitative variables, were recorded as frequencies and percentages. Results: Out of 80 patients with suspected SBP 38(47.5%) were culture positive while 42(52.5%) were culture negative. Among these 14(36.84%) showed gram positive growth and 20(52.63%) gram negative growth while 4(10.52%) showed anaerobes. Most of the organisms were resistant to ceftazidim, cefoperazone & augmentin while sensitive to levofloxacin, ceftriaxone, cefotaxime and ciprofloxacin. Highest resistance was against ceoftazidim which was 36(95%) followed by cefoperazone 35(92%). Conclusions: Spontaneous bacterial peritonitis is devastating complication of liver cirrhosis and ascites and is a leading cause of disability and death in patients with chronic liver disease. Early diagnosis and treatment with proper antibiotics and dosage are necessary for better outcome.